What is the role of inflammatory markers in predicting spontaneous ureteral stone passage?

Abstract

Purpose: To investigate the role of inflammatory markers in predicting the spontaneous passage of ureteral stones.

Methods: We retrospectively reviewed 279 patients with ureteral stones sized 4–10 mm that were managed conservatively. The patients were divided into two groups: Group 1 consisted of 137 patients who passed the stone spontaneously; Group 2 comprised 142 patients without spontaneous stone passage. The groups were compared using the Mann-Whitney U and chi-square tests. In addition, univariate and multivariate analyses were performed to identify the significance of the parameters.

Results: The mean age of the patients was 41.2 years. The patients in Group 1 had a significantly lower mean stone size, white blood cell count and neutrophil count. In addition, stone location, presence of hydronephrosis and history of urolithiasis were significantly different between the groups. Neutrophil percentage, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were insignificantly lower in Group 1. In a multivariate analysis, stone size, distal location and hydronephrosis status significantly predicted the spontaneous stone passage. However, inflammatory markers including white blood cell count, neutrophil count and neutrophil-to-lymphocyte ratio could not determine the likelihood of spontaneous stone passage.

Conclusion: Our results suggest that inflammatory markers are no meaningful parameters for the prediction of spontaneous stone passage.

Zusammenfassung

Zusammenfassung Es geht um eine Analyse, ob Entzündungsmarker geeignet sind, den Spontanabgang eines Harnleitersteines vorhersagen zu können.

Methode Es erfolgte eine retrospektive Analyse von 279 konservativ behandelten Patienten mit einem Harnleiterstein von 4–10mm Größe. Dazu wurden die Patienten in 2 Gruppen unterteilt. Gruppe 1 bestand aus 137 Patienten, bei denen ein Spontanabgang des Uretersteines erfolgte, während bei den 142 Patienten der Gruppe 2 nicht stattfand. Der statistische Vergleich erfolgte mit dem Mann-Whitney U und dem Chi-Quadrat-Verfahren, wobei sowohl die einzelnen Parameter als auch eine multivariable Analyse angewendet wurde.

Ergebnisse Das Durchschnittsalter der Patienten betrug 41,2 Jahre. Die Patienten der Gruppe 1 hatten alle einen kleineren Stein und die Leukozyten und Granulozyten waren vermindert. Außerdem unterschieden sich beide Gruppen hinsichtlich der Steinlokalisation und der Ausprägung der Stauungsniere. Obwohl bei den Patienten in Gruppe 1 die Anzahl der Neutrophilen genauso vermindert war wie das Verhältnis von Neutrophilen zu Lymphozyten und das Verhältnis von Thrombozyten zu Neutrophilen, ergab sich für beide Gruppen kein statistischer Unterschied.In einer multivarianten Analyse waren zur Vorhersage eines Spontanabganges sowohl die Steingröße als auch die Steinlokalisation und Ausprägung der Hydronephrose signifikant. Entzündungsmarker wie eine Leukozytose oder die Anzahl der Neutrophilen oder die Ratio von Neutrophilen zu Lymphozyten ermöglichten keine Erhöhung der Zuverlässigkeit der Vorhersage, ob der Spontanabgang eines Uretersteines möglich ist.

Schlussfolgerung Unsere Ergebnisse zeigen, dass serologische Entzündungsmarker keine zuverlässige Aussage ermöglichen, ob der Spontanabgang eines Uretersteines stattfinden könnte.

Schlüsselwörter

Harnleiterstein - Entzündungsmarker - Spontane Steinpassage - Prognose

Keywords

ureteral stone - inflammatory markers - spontaneous stone passage - prognosis

• References

• 1 Sfoungaristos S, Kavouras A, Katafigiotis I. et al. Role of white blood cell and neutrophil counts in predicting spontaneous stone passage in patients with renal colic. BJU Int 2012; 110: E339-E345
• 2 Cone EB, Pareek G, Ursiny M. et al. Cost-effectiveness comparison of ureteral calculi treated with ureteroscopic laser lithotripsy versus shockwave lithotripsy. World J Urol 2017; 35: 161-166
• 3 Coll DM, Varanelli MJ, Smith RC. Relationship of spontaneous passage of ureteral calculi to stone size and location as revealed by unenhanced helical CT. AJR Am J Roentgenol 2002; 178: 101-103
• 4 Jendeberg J, Geijer H, Alshamari M. et al. Size matters: The width and location of a ureteral stone accurately predict the chance of spontaneous passage. Eur Radiol 2017; 27: 4775-4785
• 5 Türk C, Neisius A, Petrik A. European Association of Urology Guidelines on Urolithiasis Available from (Accessed 26 January 2021). et al. 2020 https://uroweb.org/guideline/urolithiasis
• 6 Assimos D, Krambeck A, Miller NL. et al. Surgical Management of Stones: American Urological Association/Endourological Society Guideline, PART II. J Urol 2016; 196: 1161-1169
• 7 Choi T, Yoo KH, Choi SK. et al. Analysis of factors affecting spontaneous expulsion of ureteral stones that may predict unfavorable outcomes during watchful waiting periods: What is the influence of diabetes mellitus on the ureter?. Korean J Urol 2015; 56: 455-460
• 8 Ongun S, Teken A, Yılmaz O. et al. Can Ureteral Jet Flow Measurement Predict Spontaneous Passage of Distal Ureteral Stones?. Urol Int 2018; 101: 156-160
• 9 Yoshida T, Inoue T, Taguchi M. et al. Ureteral wall thickness as a significant factor in predicting spontaneous passage of ureteral stones of ≤ 10 mm: a preliminary report. World J Urol 2019; 37: 913-919
• 10 Keller EX, De Coninck V, Audouin M. et al. Stone composition independently predicts stone size in 18,029 spontaneously passed stones. World J Urol 2019; 37: 2493-2499
• 11 Kachroo N, Jain R, Maskal S. et al. Can CT-Based Stone Impaction Markers Augment the Predictive Ability of Spontaneous Stone Passage?. J Endourol 2021; 35: 429-435
• 12 Lee KS, Ha JS, Koo KC. Significance of Neutrophil-to-Lymphocyte Ratio as a Novel Indicator of Spontaneous Ureter Stone Passage. Yonsei Med J 2017; 58: 988-993
• 13 Abou Heidar N, Labban M, Bustros G. et al. Inflammatory serum markers predicting spontaneous ureteral stone passage. Clin Exp Nephrol 2020; 24: 277-283
• 14 Alshoabi SA. Association between grades of Hydronephrosis and detection of urinary stones by ultrasound imaging. Pak J Med Sci 2018; 34: 955-958
• 15 Li XD, Wu YP, Wei Y. et al. Predictors of Recoverability of Renal Function after Pyeloplasty in Adults with Ureteropelvic Junction Obstruction. Urol Int 2018; 100: 209-215
• 16 Nguyen HT, Herndon CD, Cooper C. et al. The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol 2010; 6: 212-231
• 17 Innes GD, Scheuermeyer FX, McRae AD. et al. Which Patients Should Have Early Surgical Intervention for Acute Ureteral Colic?. J Urol 2021; 205: 152-158
• 18 Tchey DU, Ha YS, Kim WT. et al. Expectant Management of Ureter Stones: Outcome and Clinical Factors of Spontaneous Passage in a Single Institution's Experience. Korean J Urol 2011; 52: 847-851
• 19 Modai J, Avda Y, Shpunt I. et al. Prediction of Surgical Intervention for Distal Ureteral Stones. J Endourol 2019; 33: 750-754
• 20 Shah TT, Gao C, Peters M. et al. Factors associated with spontaneous stone passage in a contemporary cohort of patients presenting with acute ureteric colic: results from the Multi-centre cohort study evaluating the role of Inflammatory Markers In patients presenting with acute ureteric Colic (MIMIC) study. BJU Int 2019; 124: 504-513
• 21 McLarty R, Assmus M, Senthilselvan A. et al. Patient Reported Outcomes Predicting Spontaneous Stone Passage May Not Have Acceptable Accuracy. J Urol 2020; 204: 524-530
• 22 Özcan C, Aydoğdu O, Senocak C. et al. Predictive Factors for Spontaneous Stone Passage and the Potential Role of Serum C-Reactive Protein in Patients with 4 to 10 mm Distal Ureteral Stones: A Prospective Clinical Study. J Urol 2015; 194: 1009-1013
• 23 Jain A, Sreenivasan SK, Manikandan R. et al. Association of spontaneous expulsion with C-reactive protein and other clinico-demographic factors in patients with lower ureteric stone. Urolithiasis 2020; 48: 17-22
• 24 Kolaczkowska E, Kubes P. Neutrophil recruitment and function in health and inflammation. Nat Rev Immunol 2013; 13: 159-175
• 25 Forget P, Khalifa C, Defour JP. et al. What is the normal value of the neutrophil-to-lymphocyte ratio?. BMC Res Notes 2017; 10: 12
• 26 Gasparyan AY, Ayvazyan L, Mukanova U. et al. The Platelet-to-Lymphocyte Ratio as an Inflammatory Marker in Rheumatic Diseases. Ann Lab Med 2019; 39: 345-357
• 27 Park CH, Ha JY, Park CH. et al. Relationship Between Spontaneous Passage Rates of Ureteral Stones Less Than 8 mm and Serum C-Reactive Protein Levels and Neutrophil Percentages. Korean J Urol 2013; 54: 615-618
• 28 Cilesiz NC, Ozkan A, Kalkanli A. et al. Can serum procalcitonin levels be useful in predicting spontaneous ureteral stone passage?. BMC Urol 2020; 20: 42